title: Sentinel lymph node mapping with pathologic ultrastaging: a valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion.
abstract: OBJECTIVE
  To report the incidence of nodal metastases in patients presenting with presumed low-grade endometrioid adenocarcinomas using a sentinel lymph node (SLN) mapping protocol including pathologic ultrastaging.
  
  
  METHODS
  All patients from 9/2005 to 12/2011 who underwent endometrial cancer staging surgery with attempted SLN mapping for preoperative grade 1 (G1) or grade 2 (G2) tumors with <50% invasion on final pathology, were included. All lymph nodes were examined with hematoxylin and eosin (H&E). Negative SLNs were further examined using an ultrastaging protocol to detect micrometastases and isolated tumor cells.
  
  
  RESULTS
  Of 425 patients, lymph node metastasis was found in 25 patients (5.9%) on final pathology-13 cases on routine H&E, 12 cases after ultrastaging. Patients whose tumors had a DMI <50% were more likely to have positive SLNs on routine H&E (p<0.005) or after ultrastaging (p=0.01) compared to those without myoinvasion.
  
  
  CONCLUSIONS
  Applying a standardized SLN mapping algorithm with ultrastaging allows for the detection of nodal disease in a presumably low-risk group of patients who in some practices may not undergo any nodal evaluation. Ultrastaging of SLNs can likely be eliminated in endometrioid adenocarcinoma with no myoinvasion. The long-term clinical significance of ultrastage-detected nodal disease requires further investigation as recurrences were noted in some of these cases.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Christine H
authors.initials: CH
authors.lastname: Kim
authors.forename: Fady
authors.initials: F
authors.lastname: Khoury-Collado
authors.forename: Emma L
authors.initials: EL
authors.lastname: Barber
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.forename: Vicky
authors.initials: V
authors.lastname: Makker
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Kaled M
authors.initials: KM
authors.lastname: Alektiar
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy
keywords: Endometrial cancer staging; Isolated tumor cells; Low-grade endometrioid carcinoma; Micrometastasis; Sentinel lymph node mapping; Ultrastaging